Midwives safe and cost-effective

Thursday, 19 September 2013

Using a midwife can result in fewer interventions and lower cost than other maternity care new research has found.

Continued care from a named midwife throughout pregnancy, birth, and after the baby is born (caseload midwifery) is just as safe as standard maternity care (shared between rostered midwives, and medical practitioners in discrete wards or clinics) for all women irrespective of risk, and is significantly cheaper, according to new ACU research published in The Lancet.

Director of Midwifery Research Unit and Chair of Midwifery at ACU and Mater Research Professor Sue Kildea took part in the study. “This trial is extremely important as we now have very strong evidence to show that changing the way midwives work is safe, actually better on many counts for mothers and babies, and costs less. If midwifery group practice was a pill it would be prescribed for all women in pregnancy!” Professor Kildea said.

The Midwives @ New Group practice Options (M@NGO) study randomly assigned pregnant women (aged 18 or older) from two metropolitan teaching hospitals in Australia to a named caseload midwife (or back-up caseload midwife; 871 women) or standard shared care with rostered midwives and medical practitioners (877), to compare outcomes for mothers and babies and cost of care.

The researchers noted no difference between the groups in number of caesareans, use of epidurals, instrumental births, 5-minute Apgar scores of 7 or less (a 10-point system for determining a newborn's health, with 10 being the healthiest), admission to neonatal intensive care, or preterm birth.

However, women who received caseload midwifery care were less likely to have an elective caesarean (before the onset of labour), more likely to have a spontaneous labour, required less pain drugs and had less blood loss following birth, needed to stay in hospital for less time, and had improved breastfeeding rates—which together, say the authors, accounted for the lower cost of caseload midwifery.

Study leader Professor Sally Tracy from the University of Sydney said caseload midwifery cost roughly $566.00 less per woman than current maternity care, with similar outcomes for women of any risk, which she said, “could play a major part in reducing public health expenditure in countries like the UK and Australia where standard maternity care is shared between different health professionals.”

Commenting on the study, Petra ten Hoope-Bender from Instituto de Cooperación Social Integrare in Switzerland said, “A health system that makes caseload midwifery services available to all women would provide the right services to the right women at the right time. Such an approach can reduce unnecessary interventions, iatrogenic harm, deaths, and costs. It can also strengthen the health and wellbeing of women, the start of the early years of life, and the capabilities of women to take care of their families and themselves. A crucial final piece in this study is the analysis of women’s satisfaction with caseload midwifery, to which I would recommend investigators add the satisfaction and workload of midwives.”